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Market Access

Building the “Healthcare Brain” for Bundled Payment Models

General Electric may be selling its valuable biopharma business, but the struggling company’s effort to keep GE Healthcare and its artificial intelligence capabilities could be a sign of where healthcare dollars are headed.

Corporate signals indicate the move to artificial intelligence–enabled electronic medical records is heating up and the revolution will light a fire under providers taking on greater financial risk. Tech companies like Apple, Google, Amazon, and Foxconn Technology Group are hiring healthcare executives known for their innovations and building systems that merge genomic data with AI-enabled EMRs.

With the ability to predict poor health outcomes, healthcare stakeholders believe they can reduce hospitalizations, dramatically lower readmissions, and treat chronic conditions more effectively. And with this crystal ball, the largest health systems, perhaps partnered with a tech company, can offer insurers and employers a set cost for a wide variety of services. Plenty of challenges remain, including privacy concerns as evidenced by Walmart’s recent patent to protect EMR data with blockchain technology, but intense competition surrounding EMR technology is moving the needle (HIT Infrastructure, June 22, 2018).

Employers like Walmart, Boeing, Intel, and Walt Disney World Resorts already contract directly with preferred providers to pay a set cost for common joint replacement surgeries or provide low-cost narrow network plans. Northern New Jersey–based Hackensack Meridian Health has upped the ante with a set rate for breast cancer treatment using a bundled payment model that charges fees upfront. Developed in conjunction with Cota, a data analytics firm founded by HMH physician Andrew Pecora, M.D., the model exemplifies the future of AI-enabled reimbursement.

The newest strategies to combine patient genome data in an EMR with AI should offer more granular control of costs. Illumina CEO Francis deSouzza says health systems with capitated contracts are expressing the most interest in combining AI with EMRs—Illumina produces systems that analyze patient genomes (Illumina earnings call, Oct. 23, 2018).

With AI, a computer system can use a library of evidence-based treatments and sequenced genomes to gain the ability to connect information, make predictions, and offer treatments. Danville, Pennsylvania-based Geisinger Health System, a national leader in bundled payment models, is using AI to analyze imaging results, offering speedier, life-saving diagnoses for cranial bleeds (Northeast Pennsylvania Business Journal [Scranton], July 4, 2018). Instead of warehousing patient data with no clear purpose, integrated delivery networks can use their data to find the Holy Grail, a method of pricing healthcare services that brings value to employers and accurately estimates the costs of care.

As eluded to earlier, tech companies are expanding rapidly in the healthcare sector and onboarding innovative CEOs. Google has a patent to develop an AI-enabled EMR system that will predict adverse health events and offer treatment protocols to patients. To enhance its program, Google hired former Geisinger Health System CEO David Feinberg, M.D., and former Cleveland Clinic CEO Toby Cosgrove, M.D. (Fierce Healthcare, Feb. 4, 2019).

Google’s efforts parallel a planned U.S. expansion by Taiwan-based Foxconn Health Technology Business Group that includes a partnership with newly merged powerhouse Advocate Aurora Health to build a similar EMR system that keeps employees healthy. The effort includes a $10 billion manufacturing campus for Foxconn Technology Group in Mount Pleasant, Wisconsin and Advocate Aurora’s plans to invest $250 million in a hospital and medical office complex near the planned construction site.

GE shelved a move to spin off GE Healthcare, and has instead decided to sell its biopharma business to Danaher Corp., a move that reduces debt and allows it to focus more on tech offerings. GE Healthcare is enhancing its own AI capabilities, and partners with influential IDNs such as Advent Health in Orlando to create NASA-style command centers. The centralized centers predict patient flow for an entire system to more efficiently staff beds and reduce unnecessary hospitalizations; moves that keep a health system on track with Medicare requirements and bundled payment initiatives.

On the heels of the Amazon-Berkshire Hathaway-JP Morgan Chase healthcare venture that promises to disrupt the healthcare system, the rush to marry AI and patient data is no surprise. The trick for companies speeding to develop their systems is knowing when the technology is accurate enough to make risk-based decisions.